Healthcare Provider Details

I. General information

NPI: 1801256896
Provider Name (Legal Business Name): ERIC MARIO MEJIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 01/13/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N STATE ST # A3C
LOS ANGELES CA
90033-5000
US

IV. Provider business mailing address

1100 N STATE ST # A3C
LOS ANGELES CA
90033-5000
US

V. Phone/Fax

Practice location:
  • Phone: 323-341-3814
  • Fax:
Mailing address:
  • Phone: 323-341-3814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number100062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: